KOZIER ERBS Fundamentals of NURSING NINTH EDITION Concepts
KOZIER & ERB’S Fundamentals of NURSING NINTH EDITION Concepts, Process, and Practice CHAPTER 17 Health, Wellness, and Illness Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Learning Outcomes 1. Identify influences on clients’ definitions of health, wellness, and well-being. 2. Describe five components of wellness. 3. Compare the various models of health outlined in this chapter. 4. Identify variables affecting health status, beliefs, and practices. 5. Describe factors affecting health care adherence. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Learning Outcomes (cont'd) 6. Differentiate illness from disease and acute illness from chronic illness. 7. Identify Parsons’ four aspects of the sick role. 8. Explain Suchman’s stages of illness. 9. Describe the effects of illness on individuals’ and family members’ roles and functions. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health, Wellness, Well-being • Many definitions and interpretations • Be familiar with common aspects of concepts • Consider how to individualize with specific clients Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health • Presence or absence of disease • Complete physical, mental, social wellbeing • Ability to maintain normal roles • Developmental and behavioral potential is realized to fullest extent possible • Striving toward optimal functioning • Individual perception Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Wellness • Wellness - state of well-being • 5 basic components: – Self-responsibility – An ultimate goal – A dynamic, growing process – Daily decision-making (nutrition, stress management, physical fitness, preventive health care, and emotional health) – Whole being of the individual Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 17 -2 The seven components of wellness. From Wellness: Concepts and Applications, 7 th ed. (p. 4), by D. J. Anspaugh, M. H. Hamrick, and F. D. Rosato, 2009, New York, NY: Mc. Graw-Hill. Reprinted with permission. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Physical Components of Wellness • • • Carry out daily tasks Achieve fitness Maintain nutrition Avoid abusing substances Practice positive lifestyle habits Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Social Components of Wellness • Interact successfully • Develop and maintain intimacy • Develop respect and tolerance for others Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Emotional Components of Wellness • Ability to manage stress • Ability to express emotion Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Intellectual Components of Wellness • • Ability to learn Ability to use information effectively Striving for continued growth Learning to deal with new challenges Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Spiritual Components of Wellness • Belief in some force that gives life meaning and purpose • Person’s own morals, values, and ethics Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Occupational Component of Wellness • Ability to achieve balance between work and leisure Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Environmental Components of Wellness • Ability to promote health measure that improves – Standard of living – Quality of life • Influences such as food, water, and air Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Well-being • Subjective perception of vitality and feeling well • Can be described objectively, experienced, measured • Can be plotted on a continuum Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Models of Health • • • Clinical model Role performance model Adaptive model Eudemonistic model Agent-host-environment model Health-illness continuum Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Clinical Model • Provides narrowest interpretation of health • People viewed as physiologic systems • Health identified by absence of disease or injury • State of not being “sick” • Opposite of health = disease or injury Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Role Performance Model • Able to fulfill societal roles • Viewed as healthy even if clinically ill, if still able to fulfill roles • Sickness = inability to perform one’s role Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Adaptive Model • Creative process • Disease = a failure in adaptation or maladaptation • Extreme good health = flexible adaptation to the environment • Focus is stability, with ability to grow and change Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Eudemonistic Model • Comprehensive view of health • Actualization or realization of a person’s potential • Illness = condition that prevents selfactualization • Human potential through goal-directed behavior, competent self-care Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Eudemonistic Model (cont'd) • Satisfying relationship with others • Maintaining structural integrity and harmony with social and physical environments • Health = expansion of consciousness Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Agent-Host-Environment Model • Each factor constantly interacts with the others • When in balance, health is maintained • When not in balance, disease occurs Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 17 -3 The agent–host–environment triangle. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health-Illness Continuum • Measures person’s perceived level of wellness • Health and illness/disease opposite ends of a health continuum • Move back and forth within this continuum day by day • How people perceive themselves and how others see them affects placement on the continuum Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 17 -5 A, Illness-Wellness Continuum. From Wellness Workbook: How to Achieve Enduring Health and Vitality, 3 rd ed. , by J. W. Travis and R. S. Ryan, 2004, Berkeley, CA: Celestial Arts. Retrieved from http: //www. thewellspring. com/wellspring/introduction-to-wellness/357/key-concept-1 -the-illnesswellnesscontinuum. cfm Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Variables Influencing Health Status, Beliefs, and Practices • Internal variables • External variables Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Internal Variables • Biologic dimension – genetic makeup, gender, age, and developmental level • Psychologic dimension – mind-body interactions and self-concept • Cognitive dimension – lifestyle choices and spiritual and religious beliefs Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
External Variables • • Physical environment Standards of living Family and cultural beliefs Social support networks Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health Belief Models • Help determine whether individual is likely to participate in disease prevention and health promotion activities • Health Locus of Control Model – Internals - health status is under their own or others’ control – Externals - health is largely controlled by outside sources Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health Belief Models (cont'd) • Rosenstock’s and Becker’s Health Belief Models – Individual’s perception – Modifying factors – Likelihood of action Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Figure 17 -6 The health belief model. From “Selected Psychosocial Models and Correlates of Individual Health. Related Behaviors, ” by M. H. Becker et al. , 1977, Medical Care, 15(5 Suppl), pp. 27– 46. Reprinted with permission. Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health Care Adherence Client motivation Degree of lifestyle change Perceived severity of health care problem Value placed on reducing threat of illness Ability to understand perform specific behaviors • Degree of inconvenience of illness itself or of health regimens • • • Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health Care Adherence (cont'd) • Beliefs that prescribed therapy or regimen will or will not help • Complexity, side effects, and duration of proposed therapy • Cultural heritage, beliefs, or practices that support or conflict with regimen Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Health Care Adherence (cont'd) • Degree of satisfaction and quality and type of relationship with health care providers • Overall cost of therapy Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Illness • A highly personal state • Person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished • Not synonymous with disease • May or may not be related to disease • Only person can say he or she is ill Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Disease • Alteration in body function • Reduction of capacities or shortening of normal life span • Causation of disease is called etiology Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Acute Illness • Characterized by symptoms of relatively short duration • Symptoms appear abruptly, subside quickly • May or may not require intervention by health care professionals • Most people return to normal level of wellness Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Chronic Illness • Usually slow onset and lasts for 6 months or longer • Often has periods of remission (symptoms disappear) and exacerbation (symptoms reappear) • Care includes promoting independence, sense of control, and wellness • Client must learn how to live with physical limitations and discomfort Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Parson’s Four Aspects of Sick Role • Right to not be held responsible for their condition • Right to be excused from certain social roles and tasks • Obligation to try to get well as quickly as possible • Obligation to seek competent help Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Suchman’s Stages of Illness • Stage 1: Symptom experience – Believes something is wrong • Stage 2: Assumption of the sick role – Accepts the sick role and seeks confirmation • Stage 3: Medical care contact – Seeks advice of a health professional Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Suchman’s Stages of Illness (cont'd) • Stage 4: Dependent client role – Becomes dependent on professional for help • Stage 5: Recovery or rehabilitation – Relinquishes dependent role – Resumes former roles and responsibilities Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Effects of Illness • Impact on the client – Behavioral and emotional changes – Self-concept and body image changes – Lifestyle changes • Impact on family depends on: – Which family member is ill – Seriousness and length of illness – Cultural and social customs of family Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Impact on the Family: Changes • • • Role changes Task reassignments Increased demands on time Stress due to anxiety about outcomes Conflict about unaccustomed responsibilities Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Impact on the Family: Changes (cont’d) • Financial problems • Loneliness as result of separation or loss • Change in social customs Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
Question Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Audrey Berman • Shirlee Snyder Copyright © 2012 by Pearson Education, Inc. All rights reserved.
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